Sarcoma Resection With and Without Vascular Reconstruction: A Matched Case-control Study - PubMed (original) (raw)

Comparative Study

. 2015 Oct;262(4):632-40.

doi: 10.1097/SLA.0000000000001455.

Thuy B Tran, Eduardo Zambrano, Lucas Janson, David G Mohler, Matthew W Mell, Raffi S Avedian, Brendan C Visser, Jason T Lee, Kristen Ganjoo, E John Harris, Jeffrey A Norton

Affiliations

Comparative Study

Sarcoma Resection With and Without Vascular Reconstruction: A Matched Case-control Study

George A Poultsides et al. Ann Surg. 2015 Oct.

Abstract

Objective: To examine the impact of major vascular resection on sarcoma resection outcomes.

Summary background data: En bloc resection and reconstruction of involved vessels is being increasingly performed during sarcoma surgery; however, the perioperative and oncologic outcomes of this strategy are not well described.

Methods: Patients undergoing sarcoma resection with (VASC) and without (NO-VASC) vascular reconstruction were 1:2 matched on anatomic site, histology, grade, size, synchronous metastasis, and primary (vs. repeat) resection. R2 resections were excluded. Endpoints included perioperative morbidity, mortality, local recurrence, and survival.

Results: From 2000 to 2014, 50 sarcoma patients underwent VASC resection. These were matched with 100 NO-VASC patients having similar clinicopathologic characteristics. The rates of any complication (74% vs. 44%, P = 0.002), grade 3 or higher complication (38% vs. 18%, P = 0.024), and transfusion (66% vs. 33%, P < 0.001) were all more common in the VASC group. Thirty-day (2% vs. 0%, P = 0.30) or 90-day mortality (6% vs. 2%, P = 0.24) were not significantly higher. Local recurrence (5-year, 51% vs. 54%, P = 0.11) and overall survival after resection (5-year, 59% vs. 53%, P = 0.67) were similar between the 2 groups. Within the VASC group, overall survival was not affected by the type of vessel involved (artery vs. vein) or the presence of histology-proven vessel wall invasion.

Conclusions: Vascular resection and reconstruction during sarcoma resection significantly increases perioperative morbidity and requires meticulous preoperative multidisciplinary planning. However, the oncologic outcome appears equivalent to cases without major vascular involvement. The anticipated need for vascular resection and reconstruction should not be a contraindication to sarcoma resection.

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Figures

FIGURE 1

FIGURE 1

Preoperative computed tomography images (left), intraoperative image of the tumor with involved vessels (middle) and of the completed vascular reconstruction (right) in four patients who underwent retroperitoneal sarcoma resection with en bloc major blood vessel resection and reconstruction. Each row represents a different patient (with the head oriented towards the top and the feet towards the bottom of the picture). First row: Left lower quadrant leiomyosarcoma encasing the iliac artery and vein; both vessels were reconstructed with cryopreserved iliac artery allografts given the need for sigmoid colectomy. Second row: Well-differentiated liposarcoma of the root of the mesentery involving the aorta (180 degrees) and the IVC (< 180 degrees). The third and fourth portions of the duodenum were resected en bloc and the pancreas and SMA have been dissected off and are retracted superiorly. The infrarenal aorta was replaced with a cryopreserved aortic allograft and the anteromedial portion of the IVC was excised and primarily repaired. Third row: Infrarenal IVC leiomyosarcoma encasing the aorta. The aorta was replaced with an aortoiliac Dacron (polyethylene terephthalate) graft and the IVC with an iliocaval ringed PTFE (polytetrafluoroethylene) graft. Fourth row: Fibromyxoid sarcoma encasing the thoracoabdominal aorta. This was replaced with a Dacron graft with additional grafts to the hepatic, SMA, and left renal arteries.

FIGURE 2

FIGURE 2

Comparison of overall survival (A) and time to local recurrence (B) between the VASC and NO VASC groups. Comparison of overall survival (C) based on whether vascular resection involved arterial or venous structures only (VASC patients only). Comparison of overall survival (D) based on whether the vessel removed was histologically invaded by sarcoma (VASC patients only).

FIGURE 3

FIGURE 3

Patency rates (continuous line: primary patency, dashed line: assisted primary patency) of arterial (A) and venous (B) reconstructions stratified by anatomic site.

References

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